Tuberculosis, also known as consumption, is a potentially fatal, highly contagious disease that "can spread to any organ in [the] body—and most often is found in the lungs" ("Tuberculosis," WebMD). The disease was prevalent in the United States at the turn of the century. In some parts of the country it caused more deaths than any other illness. Since the disease flourishes when people live in close quarters, have poor nutrition, and suffer from weakened immune systems, tuberculosis has struck blue-collar workers more heavily than it has other groups (Frieden, Lerner and Rutherford, p. 1088). As is noted in the pamphlet by Lawson Andrew Scruggs, African Americans also suffered disproportionately from tuberculosis around the turn of the century, primarily because of the reasons listed above.

Until the discovery of antibiotics in the 1950s, tuberculosis treatment centered on controlling the spread of the disease. Since tuberculosis is airborne, home confinement and sanatoria were often used in the 1800s and 1900s to limit the spread of the disease while treating the ill patient. In their 2000 article "Lessons from the 1800s: Tuberculosis Control in the New Millennium," Frieden, Lerner and Rutherford note that the "best treatment available at the time" included "bed rest, fresh air, and nutritional support" (p. 1089). Given western North Carolina's temperate climate, it is perhaps no surprise that it became home to many sanatoria, including the Mountain and Pickford Sanatoria, described below. Indeed, by 1930, "Asheville [boasted] 20 tuberculosis specialists and 25 sanitaria with a total of 900 beds" (National Park Service).

The Mountain Sanatorium, advertised in William Gleitsmann's pamphlet Mountain Sanitarium for Pulmonary Diseases, Asheville, N.C., published in the 1870s, argues that Asheville "has for a long time been visited by such patients, and its climate is well known to exert a beneficial influence on Consumptives" (p. 1). "The pure, clean mountain air," combined with the "southerly situation," make Asheville pleasant in both winter and summer (p. 1). The sanitarium opened under the charge of the author, Dr. William Gleitsmann of Baltimore. Stressing the importance of adequate nutrition to successful convalescence, the institution offered patients a "rich, nutritious diet, suitable to their condition, along with "board, including light, fire and nurse" for "$10 to $12, according to rooms, payable weekly in advance" (p. 1).

The undated pamphlet The Pickford Sanitarium for Consumptive Negroes, Southern Pines, N.C. (author unknown) also emphasizes the palliative power of North Carolina, touting "the healthful pine belt" and "high ground" of Southern Pines, N.C. (p. 2). The pamphlet advertises three buildings on the four-acre estate, including "a fine building with sun parlors and ample piazzas . . . for the especial use of women" (p. 2). The Pickford Sanatorium was "the only one in the South built and equipped for the special treatment of those diseases of the throat and lungs so prevalent amongst colored people" (p. 2). Open from November until April, the Pickford Sanatorium charged "Fifteen dollars per month" in order to provide patients with "those plans and methods which are used most successfully in Institutions of this kind at the North" (pp. 2-3). W.E.B. Du Bois (1868-1963), a prominent African American sociologist, singled out and lauded the Pickford Sanatorium for its accomplishments in aiding African Americans.

In 1897, the Pickford Sanatorium was discussed at length, along with other issues relating to tuberculosis and its treatment, in The Southern Sanitarium, a journal edited by Lawson Andrew Scruggs (1857-1914), the lead doctor of the Pickford Sanitarium. The journal features sketches of some of the buildings located on the Pickford grounds and reports that the four-acre estate will eventually boast "sixteen Pavilions . . . and one Central or Administration Building." At the time of publication, four pavilions had been pledged, "two of which have been completed and paid for and partly furnished" (p. 1).

The first article of this publication, originally published in the Louisville Medical Journal, addresses the contagiousness of tuberculosis and concludes that "the great majority of medical authorities on both sides of the Atlantic seem to be very well agreed that consumption is contagious or catching" (p. 1). That assumption led to the construction of the Pickford Sanitarium, as African Americans often lived in close quarters and were therefore susceptible to contagion: "What can we hope for but a rapid increase of consumption, when in many cases a whole family of as many as six, eight or ten persons live, cook, eat, wash and SLEEP in one room that has scarcely the capacity for two or three at most . . . Do you wonder that the disease spreads rapidly?" (p. 1). The article takes the position that those inflicted with tuberculosis should be forbidden to marry and that "the family physician can warn parents of the dangers of such unions without offending or appearing officious" (p. 1).

Scruggs lists eleven "probable causes of the rapid spread of consumption among the negroes," including "[l]iving in crowded and unsanitary tenement houses," "[t]he assumption of great responsibilities," and "[o]ver crowded and badly ventilated churches and schools" (pp. 8-9). However, Scruggs notes the "well-known fact that all of the hotels (many of which are but sanitary institutions) here in the South, as well as the special sanitary institutions for consumptives, are, by long-standing customs and laws, closed against the Negro" (p. 9). Even if such institutions accepted African American patients, argues Scruggs, few would be able to pay the weekly rates for care. After providing two examples of patients who suffered and died from tuberculosis without proper aid or comfort, the author acknowledges one of the important roles of the Pickford Sanitarium: "If we could not cure them we might give them comfortable quarters in which to die, at least" (p. 12).

Yet the Pickford Sanitarium was not focused solely on the potential fatality of tuberculosis. Scruggs notes that "[n]o unnecessary idleness will be encouraged at this institution" (p. 13) Instead, patients will be able to work as gardeners, carpenters, printers, and other related "homelike employment" in order to "help in expanding the lung cells to a moderate degree" while also "securing . . . necessary muscular development" (p. 13). Scruggs asks readers to make donations of goods or money so that the sanitarium can continue its work. Appealing to the readers' sympathy, Scruggs notes that "[i]n one city here in the South, the number of deaths from consumption in ten years was 3,119, of which 611 were white people and 2,508 were colored people," despite the fact that "negroes in this country constitute less than . . . one tenth of the population, and at the same time nearly 40 per cent. of the mortality from consumption alone" (pp. 14-15).

Works Consulted: "Asheville, NC: Asheville as a Health Retreat," National Park Service, accessed 10 January 2010 ; Du Bois, W.E.B., Some Efforts of American Negroes for Their Own Social Betterment, Atlanta University Press, 1989; Fairchild, Amy L. and Gerald M. Oppenheimer, "Public Health Nihilism vs. Pragmatism: History, Politics, and the Control of Tuberculosis," American Journal of Public Health 88.7, July 1998, pgs. 1105-1117; Frieden, Thomas R., Barron H. Lerner, and Bret R. Rutherford, "Lessons from the 1800s: Tuberculosis Control in the New Millennium," The Lancet 355, March 25, 2000, pgs. 1088-1092; "Tuberculosis," WebMD, accessed 10 January 2010.